Does chemotherapy improve survival in high-risk Stage I and II Merkel cell carcinoma of the skin?

Purpose: The effectiveness of synchronous carboplatin, etoposide, and radiation therapy in improving survival was evaluated by comparison of a matched set of historic control subjects with patients treated in a prospective Phase II study that used synchronous chemotherapy and radiation and adjuvant chemotherapy. Patients and Methods: Patients were included in the analysis if they had disease localized to the primary site and nodes, and they were required to have at least one of the following high-risk features: recurrence after initial therapy, involved nodes, primary size greater than 1 cm, or gross residual disease after surgery. All patients who received chemotherapy were treated in a standardized fashion as part of a Phase II study (Trans-Tasman Radiation Oncology Group TROG 96:07) from 1997 to 2001. Radiation was delivered to the primary site and nodes to a dose of 50 Gy in 25 fractions over 5 weeks, and synchronous carboplatin (AUC 4.5) and etoposide, 80 mg/m(2) i.v. on Days 1 to 3, were given in Weeks 1, 4, 7, and 10. The historic group represents a single institution's experience from 1988 to 1996 and was treated with surgery and radiation alone, and patients were included if they fulfilled the eligibility criteria of TROG 96:07. Patients with occult cutaneous disease were not included for the purpose of this analysis. Because of imbalances in the prognostic variables between the two treatment groups, comparisons were made by application of Cox's proportional hazard modeling. Overall survival, disease-specific survival, locoregional control, and distant control were used as endpoints for the study. Results: Of the 102 patients who had high-risk Stage I and II disease, 40 were treated with chemotherapy (TROG 96:07) and 62 were treated without chemotherapy (historic control subjects). When Cox's proportional hazards modeling was applied, the only significant factors for overall survival were recurrent disease, age, and the presence of residual disease. For disease-specific survival, recurrent disease was the only significant factor. Primary site on the lower limb had an adverse effect on locoregional control. For distant control, the only significant factor was residual disease. Conclusions: The multivariate analysis suggests chemotherapy has no effect on survival, but because of the wide confidence limits, a chemotherapy effect cannot be excluded. A study of this size is inadequately powered to detect small improvements in survival, and a larger randomized study remains the only way to truly confirm whether chemotherapy improves the results in high-risk MCC. (c) 2006 Elsevier Inc.

Presentation and detection of invasive melanoma in a high-risk population

Background: Early detection of melanoma has been encouraged in Queensland for many years, yet little is known about the patterns of detection and the way in which they relate to tumor thickness. Objective: Our purpose was to describe current patterns of melanoma detection in Queensland. Methods: This was a population-based study, comprising 3772 Queensland residents diagnosed with a histologically confirmed melanoma between 2000 and 2003. Results: Almost half (44.0%) of the melanomas were detected by the patients themselves, with physicians detecting one fourth (25.3%) and partners one fifth (18.6%). Melanomas detected by doctors were more likely to be thin (\0.75 mm) than those detected by the patient or other layperson. Melanomas detected during a deliberate skin examination were thinner than those detected incidentally. Limitations: Although a participation rate of 78% was achieved, as in any survey, nonresponse bias cannot be completely excluded, and the ability of the results to be generalized to other geographical areas is unknown. Conclusion: There are clear differences in the depth distribution of melanoma in terms of method of detection and who detects the lesions that are consistent with, but do not automatically lead to, the conclusion that promoting active methods of detection may be beneficial. ( J Am Acad Dermatol 2006;54:783-92.)

Reduced nephron number and glomerulomegaly in Australian Aborigines: A group at high risk for renal disease and hypertension

Aborigines in remote areas of Australia have much higher rates of renal disease, as well as hypertension and cardiovascular disease, than non-Aboriginal Australians. We compared kidney findings in Aboriginal and non-Aboriginal people in one remote region. Glomerular number and mean glomerular volume were estimated with the disector/fractionator combination in the right kidney of 19 Aborigines and 24 non-Aboriginal people undergoing forensic autopsy for sudden or unexpected death in the Top End of the Northern Territory. Aborigines had 30% fewer glomeruli than non-Aborigines-202000 fewer glomeruli per kidney, or an estimated 404000 fewer per person (P=0.036). Their mean glomerular volume was 27% larger (P=0.016). Glomerular number was significantly correlated with adult height, inferring a relationship with birthweight, which, on average, is much lower in Aboriginal than non-Aboriginal people. Aboriginal people with a history of hypertension had 30% fewer glomeruli than those without-250000 fewer per kidney (P=0.03), or 500000 fewer per person, and their mean glomerular volume was about 25% larger. The lower nephron number in Aboriginal people is compatible with their susceptibility to renal failure. The additional nephron deficit associated with hypertension is compatible with other reports. Lower nephron numbers are probably due in part to reduced nephron endowment, which is related to a suboptimal intrauterine environment. Compensatory glomerular hypertrophy in people with fewer nephrons, while minimizing loss of total filtering surface area, might be exacerbating nephron loss. Optimization of fetal growth should ultimately reduce the florid epidemic of renal disease, hypertension, and cardiovascular disease.

Self-reported risk perception, mood and risk behaviour across the human menstrual cycle

Normally ovulating women exhibit a decline in risk behaviours that may lead to sexual assault during the fertile phase of the menstrual cycle, whereas women using the Pill do not. The current study tests two explanatory models: the mood and fertility models. Self-reported risk and non-risk behaviours, mood, and risk perception in sexual assault and physical risk domains were assessed by testing fiftyone women at menstruation and during their fertile period. Based on the decline in risk behaviours shown in past research, the fertility model predicts that normally ovulating women will display greater risk perception during the fertile phase of their cycle. The mood model predicts that at menstruation, when negative mood is highest, risk perception will be increased and risk behaviours correspondingly reduced. Risk behaviours did not vary over the cycle or between groups. Overall, results support the mood model. Negative mood was greater at menstruation and positive mood during the fertile period for both groups, rational risk perception was correspondingly greater at menstruation. The fertility model was not supported as risk perception ratings did not vary in the expected direction and ratings were not specific to the sexual assault domain.

Cadmium in the environment and high risk population groups

Cadmium has been widely used in various industries for the past fifty years, with current world production standing at around 16,755 tonnes per year. Very little cadmium is ever recycled and the ultimate fate of all cadmium is the environment. In view of reports that cadmium in the environment is increasing, this thesis aims to identify population groups 'at risk' of receiving dietary intakes of cadmium up to or above the current Food and Agricultural Organisation/World Health Organisation maximum tolerable intake of 70 ug/day. The study involves the investigation of one hundred households (260 individuals) who grow a large proportion of their vegetable diet in garden soils in the Borough of Walsall, part of an urban/industrial area in the United Kingdom. Measurements were made of the cadmium levels in atmospheric deposition, soil, house dust, diet and urine from the participants. Atmospheric deposition of cadmium was found to be comparable with other urban/industrial areas in the European Community, with deposition rates as high as 209 g ha-1 yr-1. The garden soils of the study households were found to contain up to 33 mg kg-1 total cadmium, eleven times the highest level usually found in agricultural soils. Dietary intakes of cadmium by the residents from food were calculated to be as high as 68 ug/day. It is suggested that with intakes from other sources, such as air, adventitious ingestion, smoking and occupational exposure, total intakes of cadmium may reach or exceed the FAO/WHO limit. Urinary excretion of cadmium amongst a non-smoking, non-occupationally exposed sub-group of the study population was found to be significantly higher than that of a similar urban population who did not rely on home-produced vegetables. The results from this research indicate that present levels of cadmium in urban/industrial areas can increase dietary intakes and body burdens of cadmium. As cadmium serves no useful biological function and has been found to be highly toxic, it is recommended that policy measures to reduce human exposure on the European scale be considered.

Does Lost Time Cost You Money and Create High Risk?

The aim of the case study is to express the delayed repair time impact on the revenues and profit in numbers with the example of the outage of power plant units. Main steps of risk assessment: • creating project plan suitable for risk assessment • identification of the risk factors for each project activities • scenario-analysis based evaluation of risk factors • selection of the critical risk factors based on the results of quantitative risk analysis • formulating risk response actions for the critical risks • running Monte-Carlo simulation [1] using the results of scenario-analysis • building up a macro which creates the connection among the results of the risk assessment, the production plan and the business plan.

An examination of the effects of a summer book-reading program on the language and early literacy outcomes of toddlers from high risk environments

The current study examined the impact of an early summer literacy program and the mediating effects of the home literacy environment on the language and literacy outcomes of a group of children at-risk for long-term developmental and academic delays. Participating children (n=54) were exposed to an intensive book-reading intervention each summer (June through mid August) over a 3-year period. The current study implemented an ex post facto, quasi-experimental design. This nonequivalent group design involved a pretest and posttest over three time points for a non-randomized treatment group and a matched non-treatment comparison group. Results indicated that literacy scores did improve for the children over the 3-year period; however, language scores did not experience the same rate of change over time. Receptive language was significantly impacted by attendance, and race/ethnicity. Expressive language was impacted significantly by gestational age and attendance. Results also indicated that language outcomes for young children who are exposed to a literacy program were higher than those who did not participate; however, only receptive language yielded significance at the p<.05 level. These study results also found that activities in the home that support literacy and learning do indeed impact language and literacy outcomes for these children, specifically, the age at which a child is read to, the number of books in the home, a child’s enjoyment of reading, and whether a child looks at books on his or her own impact language scores. This study concluded that at-risk young children do benefit from center-based literacy intervention. This literacy experience, however, is also driven by the children's home environment, their attendance to the program, whether they were premature or not and the type of caregiver.

An evaluation of an intervention strategy for retention and determination of predictors of success for high -risk students in an associate degree nursing program

The purpose of this study was twofold: (1) to evaluate the effect of a specific instructional Intervention, a Nursing Theory Laboratory, on increasing the retention of high risk students in the associate degree nursing program at Miami-Dade Community College in Miami, Florida; and (2) to identify predictors of success of high risk nursing students in this associate degree nursing program.^ Data were collected from the 195 nursing students enrolled in Nursing Fundamentals during the 1985-1987 academic years, and identified as high risk students. Control and experimental groups were selected based on enrollment in the Nursing Theory Laboratory.^ Results were determined by analyzing several cross-tabulations of selected variables and yielding chi square values, t-tests, and two discriminant analyses. There was no significant relationship between age or ethnic background and enrollment in the Nursing Theory Laboratory. There was no significant relationship between enrollment in the Nursing Theory Laboratory and success in Nursing 1 (Nursing Fundamentals). There was a significant relationship between enrollment in the Nursing Theory Laboratory and success in Nursing 3 (Medical-Surgical Nursing). Writing assessment test scores in two entrance tests and high risk categories, based on the number of enrollments in required science courses, were identified as predictors of success in this program.^ The conclusion was that the Nursing Theory Laboratory does not significantly improve retention of high risk associate degree nursing students if they are enrolled in this intervention at the same time they are enrolled in Nursing Fundamentals. Since those students who were enrolled in the Nursing Theory Laboratory had a significantly higher success rate in Nursing 3, than those students who were not enrolled in the Nursing Theory Laboratory, a recommendation of this study was to offer the Nursing Theory Laboratory to high risk students prior to the beginning of nursing courses. Another recommendation was that students deficient in reading and writing skills should be required to enroll in developmental courses prior to enrollment in the nursing course. ^